Integration-based scale up of tuberculosis control in Japan

Failure of tuberculosis control in developing countries is often blamed on ill-functioning health systems. Successful scale up of tuberculosis control therefore necessitates scale up of health systems. However, how to make the optimal use of available resources to meet the need is a parallel dilemma for many countries. In 1950, Japan faced the dilemma. Tuberculosis was extremely prevalent and was considered as the “national disease.” The health system was not functioning well and economic situations were considerably poor. Japanese approach was to address tuberculosis extensively and scale up tuberculosis control in line with the framework for the health system scale up. The basic financing, payment and organizational mechanisms for tuberculosis control were the same for the health system control. However, specific mechanisms were added: e.g., governmental subsidies for financing and tuberculosis advisory committees for payment. This integration-based scale up worked very well in Japan, as tuberculosis mortality declined extremely rapidly. Japanese experience is however not simply replicable in developing countries because of the external uniqueness that Japan enjoyed: particularly the rapid economic and social development. Still, the philosophy that Japanese official built, that is to say addressing tuberculosis extensively while keeping primary health care always in mind, or “Think PHC, Do TB,” is still meaningful at the present time.